经皮加压钢板结合旋股外侧动脉升支髂骨瓣移植治疗青壮年股骨颈骨折骨不连疗效观察

目的　探讨应用经皮加压钢板(percutaneous compression plate，PCCP) 内固定结合带旋股外侧动脉升支髂骨瓣移植术治疗中青年股骨颈骨折骨不连的临床效果。 方法　自2013年6月至2016年3月采用PCCP内固定结合带旋股外侧动脉升支髂骨瓣移植术治疗8例患者,其中男7例，女1例,年龄19~42岁,平均26.5岁。Garden分型：Ⅱ型1例，Ⅲ型4例，Ⅳ型3例。两次手术时间间隔7~15个月，平均9.2个月。 结果　所有患者均获随访,随访时间9~42个月,平均随访时间22.3个月,术后8例患者均达到骨性愈合,骨折愈合时间3~9个月，平均4.6个月，未发生骨不连或股骨头坏死。末次随访患者髋关节功能良好，Harris评分达91.7分，Matta髋关节功能评价：优7例，良1例，优良率达100%。 结论　对于青壮年不宜行髋关节置换的股骨颈骨折骨不连患者，PCCP结合带旋股外侧动脉升支髂骨瓣移植手术方式早期疗效满意，具有安全性高,固定牢固，愈合快，可早期负重等优点。

Effect of treatment of femoral neck fracture nonunion by percutaneous compression plate combined with ascending branch of lateral femoral circumflex artery iliac flap in young adults

Objective　To investigate the effect of percutaneous compression plate(PCCP) combined with ascending branch of lateral femoral circumflex artery iliac flap in treatment on nonunion cases of femoral neck fractures in young adults.　Methods　From June 2013 to March 2016，8 young adults patients with nonunion cases of femoral neck fracture were treated by PCCP combined with ascending branch of lateral femoral circumflex artery iliac flap. Among the 8 patients, 7 were male and 1 was female, whose age ranged from 19 to 42 yrs, with an average 26.5 yrs. For the fracture type, 1 case was Garden Ⅱ, 4 cases were Garden Ⅲ, 3 cases were Garden Ⅳ. Duration from first operation to the second was 7~15 months, averaging 9.2 months.　Results　All patients were followed up for 9 to 42 months, with a mean of 22.3 months. All fractures were healed, and the healing time was 3-9 months(4.6 months on average)．During the follow-up, the hips of 8 cases got good function, and the average Harris score was 91.7．Based on Matta evaluation, 7 cases were excellent in function，1 case was good ,the good rate being 100%.　Conclusion　PCCP covered by the iliac bone flap pedicled with the ascending branch is one of effective ways of treating nonunion cases of femoral neck fractures in young adults. It has advantages of lowing risk of complications, rigid fixation and early weight bearing．